Integrated Telehealth Rehabilitation and Quality of Life in Mechanically Ventilated Adults: A Randomized Clinical Trial.

Summary

In a stepped-wedge cluster RCT across 20 ICUs (n=1916), an integrated telehealth rehabilitation program spanning ICU-to-home modestly improved 90-day health-related quality of life overall, reduced 90-day mortality by an adjusted 7.6%, and shortened mechanical ventilation by a mean 6.2 days. Among survivors, EQ-5D did not differ, suggesting mortality reduction drove the overall QOL gain.

Key Findings

• Integrated telehealth rehabilitation improved 90-day EQ-5D utility versus usual care (adjusted difference 0.049; P=0.04).
• 90-day all-cause mortality was lower with the intervention (adjusted difference -7.6%; 95% CI -14.7% to -0.6%).
• Mean mechanical ventilation duration decreased by 6.2 days (95% CI -8.5 to -3.9).
• Among survivors, EQ-5D did not differ, implying mortality reduction primarily drove overall QOL benefit.

Clinical Implications

Health systems can adopt integrated tele-rehabilitation pathways to support ventilator liberation, risk stratification on wards, and structured post-discharge exercise/education, with expectation of lower mortality and shorter ventilation.

Limitations

• EQ-5D among survivors showed no difference, suggesting outcome sensitive to mortality effects.
• Conducted in Brazilian public hospitals; generalizability to other health systems and resource settings requires validation.

Future Directions

Delineate which tele-rehabilitation components drive benefit, cost-effectiveness across systems, and strategies to sustain gains beyond 90 days.